Hello all, iam an Intern, and this is a case history of one of our patient's who got admitted . This is to complete my log book as a part of internship duty
14/01/2020
A35year male presented with complaints of shortness of breath since 2weeks and pedal Edema since 2weeks
Patient was apparently asymptomatic 1month back then he developed fever ,associated with chills ,which is high grade for which he took treatment at local rmp where he was given anti malarial drugs and treated symptomatically after which patient felt better currently from 2weeks he is complaining of b/l pedal edema ,extending up to knees ,pitting type,progressing in nature shortness of breath from 2weeks ,initially NYHA 3 after treatment now grade 2 h/o paroxysmal nocturnal dyspnea and generalised weakness from 2weeks
No h/o fever ,vomitings ,abdominal distension ,diarrhoea ,cough,cold
PAST HISTORY :
No history of similar complaints in the past
Not a known case of DM ,HTN,Epilepsy,CVA,CAD
PERSONAL HISTORY :
mixed diet with normal appetite and normal bowel&bladder habits
H/o alcohol and smoking occasionally
No significant family history
GENERAL EXAMINATION:
well built and well nourished
Afebrile
Pallor absent
Noicterus,cyanosis,clubbing,lymphadenopathy
Edema upto knees (grade2)
BP:130/80mmhg
PR:80bpm
CVS:s1s2heard
RS:right ISA early inspiratory crepts +
P/A:soft and non tender
CNS:Hmf normal
Cranial nerves intact
Motor system normal
Sensory system normal
No cerebellar signs
JVP of this patient
https://drive.google.com/file/d/1Gr2xuU5bcPUbNmQaPjVIavwn1m-FK7gr/view?usp=drivesdk

INVESTIGATIONS:
Heamoglobin :15.2
Tlc:9600
Platelet:2.39
FBS:102
PLBS:205
Total cholesterol:150
Triglycerides:87
Hal:33
LDL:72
Vldl:17.4
Urea:24
Creatinine:0.8
Uric acid :6
USG abdomen:right moderate pleural effusion ,grade1 fatty liver,mild ascites
2D ECHO:EF-27%,IVC dilated(2.3cm)not collapsing,mild TR+,severe MR+,trivial AR+,dilated all chambers ,global hypokinesia,severe LV dysfunction,mild PAHT,no MS/AS,no PE/LV clot
DIAGNOSIS: heart failure with reduced ejection fraction secondary to viral myocarditis with denovo DM type 2
TREATMENT:
Tab.lasix 80mg...40mg...40mg
Tab.isosorbide mononitrate10mg bd
Tab.hydralazine 25mg
Tab. Telma20mg
Tab.metformin 500mg po od
Fluid restriction <1litre/day
Salt restriction <2gms/day
On 14/5/2020
Patient came for opd with complaints of pedal odema and shortness of breath since 1week
Patient is investigated for 2d echo and findings are: left ventricular dilatation ,left atrial dilatation,end point septal separation distance is increased,right atrial and ventricular dilatation ,global hypokinesia
Based on the above findings we have increased the dosage of vymarda 50mg BD (sacubitril 26mg +valsartan24mg) to vymarda to 100 mg BD
PROCEDURE:
I have seen the 2D ECHO of this patient today
https://drive.google.com/file/d/1K9Fk66l6c79ziOF-dIYQ3vDlGbSavlr7/view?usp=drivesdk
NEET TOPIC :
Myaesthenia gravis:
It is a neuromuscular diseases that lead to varying degrees to skeletal muscle weakness.
Pathophysiology:
T cell and B cell mediated activation leads to production of antibodies which causes
a)Decrease in number of acetylcholine receptors in the post synaptic membrane
b)acetylcholine cannot bind to receptors
Antibodies : such as
1)anti acetylcholine receptor antibody
2)anti musk antibody
Presenting complaints:
Starts with ocular weakness or pharyngeal weakness followed by generalised weakness (mainly proximal muscles of lower limb)
Management :
Investigations:
1)ice pack test
2)tensilon test
3)repetitive nerve stimulation tests
4)single nerve fibre electromyography
Treatment:
a)pyridostigmine:30-60mg 6th hourly later taper off
Relapse- steroid +azathioprine
Crisis- IvIg and plasma exchange
b) thymectomy.
